Do You Recognize These 6 Things Which Are Burning You Out at Work?

Physicians do not usually burn themselves out. The majority of the time it is the work environment which burns out the physician. Certain conditions and circumstances in the workplace can set-up unsuspecting doctors for job related burnout. You can take an on fire, passionate, purpose driven physician and put them in the wrong work environment and you will burn them out.

Physicians burn themselves out only about 10% of the time. In her book, The Truth About Burnout, Dr. Christina Maslach, who developed the Maslach Burnout Inventory (MBI), identified six mismatches between the work environment and the physician which ultimately leads to burnout nearly 90% of the time. I have found this to be absolutely true, especially in today’s practice environments.

These are the six major physician-workplace mismatches which have led to our current nationwide provider crisis from job related burnout. Many or all of these may sound familiar to you.

1. Work Overload. Falling reimbursement, downsizing, budget cuts, layoffs, reorganization efforts, and rising expenses all usually result in three things — more work intensity, more demands on time, more job complexity.

In short, physicians and other providers are required to do ever more with less. This can leave individuals feeling overwhelmed and exhausted.

Physicians are required to see more patients year after year just to maintain their salaries or to reach performance quotas. When I first started in private practice, seeing 15-20 patients a day seemed like a huge stretch. Now, I see 30-35 patients a day just to pay for ever expanding overhead expenses and to maintain the same salary I've had for the past twenty years.

The law of diminishing returns was violated long ago by adding more patients to the physician's schedule.

2. Lack of Control. Organizations which become intolerant of creative problem solving in lieu of centralized control will squelch individual autonomy.

This reduces a physician's capacity to set limits, exercise problem solving, select individualized approaches to work, allocate resources and set priorities. The overall effect is a loss of interest in the job and monumental frustration.

Physicians seem to be no longer in control of their schedules, patient load, or work demands. Too many mandates come down at us from above, faster than we can keep up and every year there seem to be more. Through certain "quality measures", physicians are being made responsible for their patient's behavior, over which they have no real control.

3. Insufficient reward. Market forces focusing on reducing costs have also reduced organizations’ capacity to reward employees in meaningful ways.

People seek tangible rewards from meaningful work such as money, security, recognition, benefits, intrinsic satisfaction, etc. If these are lacking people naturally begin to wonder why they are working so hard. It's a simple equation.

More Work + Less Reward = Dissatisfaction.

The ‘thanks’ physicians get in exchange for more work demands are falling reimbursements and reduced salaries. Many perks of the profession have disappeared. In addition, penalties may soon be levied for missing performance targets and quality care measures, over which physicians have very little control. It's another simple equation.

Work Buttocks Off + Some Uncontrollable Non-compliant Patients = Less Pay

Huh?

4. Breakdown of Community. As provider organizations grow larger or too quickly a breakdown in the character of the organization can result as profits are chased at the expense of interpersonal relationships.

This will inevitably lead to greater conflicts among employees, a lack of mutual support, lack of respect and a growing sense of isolation. Dr. Maslach states, “A sense of belonging disappears when people work separately instead of together.”

The current work environments are isolating physicians from one another making it more and more difficult to maintain camaraderie and collegiality among peers. No time is made for physicians to support each other at work. No incentives are offered to foster mentor relationships and provide support groups. Comparatively little money is spent by organizations on physician wellness programs. Organized activities outside of work are rarely sponsored anymore.

5. Absence of Fairness. Dr. Maslach perceives a workplace to be fair when three key elements are provided: trust, openness, and respect. When all three are present employees are valued and they will in turn feel valued and remain fully engaged (the opposite of burnout). When these elements are absent, burnout will be the direct end result.

There is no show of openness or respect when treatment decisions are constantly being made by outside parties and entities with little or no warning and without consulting the physician involved. Physicians no longer trust government agencies or insurance companies to act in the best interest of their patients and in alignment with their own morals, values and code of conduct.

6. Conflicting Values. If an organization such as a hospital or large group practice says they are dedicated to excellence service yet take actions which damage the quality of the services they provide then conflict results.

This can be extremely frustrating and demoralizing to the provider, especially if their internal moral compass or core values are being assailed. To achieve a quality product or service an employer's values must remain in alignment with those of the employees.

If employees are being asked or encouraged to be less than honest or outright dishonest in words or deeds, honest employees will burnout and leave. What remains will be an uncaring and largely dishonest workforce.

If a physician employer is requiring the provider to do something which the physician feels is not in the best interest of the patient or is against their code of ethics, the provider will burn out. Many dedicated, passionate, purpose driven physicians have been burned out in this way.

If you can identify with any of these major job mismatches and feel you’re suffering from the effects of job related burnout, seek help immediately before you get completely turned off on your noble calling — the practice of medicine. It is impossible to live a passionate, purpose driven life of significance while feeling used up and burned out. There are many programs, workshops and coaches out there which can help.